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Correlation between preoperative clinical examination and intraoperatively found subscapularis tendon tear

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European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

Analyze the diagnostic value for subscapularis (SSC) tendon tears, their correlation between pain and strength on clinical tests, and compare them with intraoperative arthroscopic findings to prove their diagnostic value.

Methods

110 consecutive patients undergoing arthroscopic rotator cuff repair were reviewed and allocated to isolated SSC (n = 39) and combined anterosuperior tendon tear (n = 71) groups and analyzed. Preoperative clinical testing included belly press (BPT), bear hug (BHT), lift-off (LOT), palm-up (PUT), and Jobe test (JT). All tests were performed in two categories: pain (in 4 categories: 0, 5, 10, and 15) and strength (from 0 to 5). The tendon tears were intraoperatively reviewed and classified.

Results

Mean age was 59 years (SD 10). The sensitivity of the BHT was 88.2% and 74.5% for BPT, while specificity was only 41.9% for BHT and 45% for BPT. Sensitivity of JT was 90.5% and 87.5% for PUT, while specificity was only 41% for JT and 28.2% for PUT. A low positive correlation for an intraoperative SSC lesion and the strength of BPT (Spearman rank correlation  − 0.425; p value < 0.0001) and the strength of BHT ( − 0.362; p value = 0.001) could be found. With linear regression analysis estimated by ordinary least squares, a correlation between BPT strength and surgical grade of SSC lesion (− 0.528; 95% CI, − 0.923 to − 0.133; pvalue < 0.01) was found.

Conclusion

The BHT showed a higher sensitivity for a SSC lesion, while the BPT had a higher correlation between preoperative testing, most notably internal rotation strength, and intraoperative surgical grade of the SSC tendon lesion.

Level of evidence

Level II, Prospective cohort study for Diagnostic tests.

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Abbreviations

BHT:

Bear hug test

BPT:

Belly press test

JT:

Jobe test

MMT:

Manual muscle testing

PUT:

Palm-up test

LOT:

Lift-off test

SSC:

Subscapularis

SSP:

Supraspinatus

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Funding

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Authors and Affiliations

  1. Alps Surgery Institute, Clinique Générale d’Annecy, 4 Chemin de la Tour la Reine, 74000, Annecy, France

    Roland Stefan Camenzind, Javier Martin Becerra, Louis Gossing, Julien Serane-Fresnel, Thibault Lafosse & Laurent Lafosse

  2. Department of Orthopedics, Balgrist University Hospital, Forchstrasse 340, 8008, Zurich, Switzerland

    Roland Stefan Camenzind & Timo O. Tondelli

  3. Ortomove, Centro Medico ABC, Av carlos graef Fernández 154 consultorio 0071, Santa Fe Cuajimalpa, 05300, Mexico City, Mexico

    Javier Martin Becerra

  4. Department of Orthopaedic Surgery, Braine-l’Alleud-Waterloo Hospital, Centre Hospitalier Interregional Edith Cavell (CHIREC), Braine-l’Alleud, Belgium

    Louis Gossing

  5. IECEM - Research Unit, Polyclinique Saint Côme, Compiègne, France

    Julien Serane-Fresnel

Authors
  1. Roland Stefan Camenzind
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  2. Javier Martin Becerra
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  3. Timo O. Tondelli
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  4. Louis Gossing
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  5. Julien Serane-Fresnel
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  6. Thibault Lafosse
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  7. Laurent Lafosse
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Correspondence to Roland Stefan Camenzind.

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Conflict of interest

Laurent Lafosse is consultant, receives royalties, hold stocks of DePuy, Oberdorf, Switzerland. All other authors have no conflict of interest.

Ethical approval

Independent institutional review board approval was obtained from the Ethics Committee of the University of Lyon, Lyon, France (Comité de Protection des Personnes SUD-EST IV, Reference No. L19-006).

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All patients provided written informed consent before participation.

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Camenzind, R.S., Martin Becerra, J., Tondelli, T.O. et al. Correlation between preoperative clinical examination and intraoperatively found subscapularis tendon tear. Eur J Orthop Surg Traumatol 33, 373–379 (2023). https://doi.org/10.1007/s00590-021-03197-5

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  • DOI: https://doi.org/10.1007/s00590-021-03197-5

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